Monday, December 7, 2009

Six years ago, Texas leaders knew the state mental health system was in bad shape.

They knew it couldn't help everyone; that patients got few services; that community mental health centers didn't consistently measure how well programs worked; that care varied from center to center.

They knew it was bad. But they couldn't tell exactly what was happening at the 39 state-funded community mental health centers, which serve indigent, low-income or uninsured people.

Now they know.

In 2003, in an effort to improve the state's mental health system amid a budget shortfall, Texas legislators transformed the public mental health system. First, they rationed state-provided services, focusing on people with schizophrenia, bipolar disorder and major depression. People with other illnesses, such as anxiety and post-traumatic stress disorder, rarely received help unless they went into crisis and threatened to harm themselves or others.

Officials say new requirements for data collection and patient tracking that were part of the change have given them the clearest picture yet of the state's mental health needs — and how well Texas is meeting them.

According to the Department of State Health Services, that picture shows:

Waiting lists for services, which were not widespread in 2003, are now filled with thousands of people who sometimes wait more than a year to get medication, therapy, substance abuse care and other services from community centers. More than 6,800 adults and children with schizophrenia, bipolar disorder and major depression are on waiting lists. Of those, 4,550 are receiving no services; the remainder are in the system but waiting for additional care.

Because of the 2003 changes, centers routinely deny care to people who don't have schizophrenia, major depression or bipolar disorder.In 2003, the Texas system served about 14,800 people with primary diagnoses such as panic disorder, borderline personality disorder or anxiety, whom centers rarely accept as patients. Today, the centers serve about 3,900 with such diagnoses. People who are no longer accepted have to get help from other agencies, such as nonprofit or private providers.

Patients who are ready to transition out of the state system often have nowhere else to get help. At Austin Travis County Integral Care — the local public mental health center — more than 500 could be getting care elsewhere, but officials say there are not enough nonprofit and private providers willing or able to help them.

People who are getting care are getting better. According to Department of State Health Services statistics, 82 percent of adults who received mental health services in fiscal year 2008 improved or stabilized. Many got housing, found jobs or were arrested less often.

Having that kind of information is critical when asking politicians for more money, said Mike Maples, assistant commissioner for the department's Mental Health and Substance Abuse Division. It has also helped the state see what additional services people need, such as trauma therapy, supportive housing and job assistance.

"Just knowing is golden," he said. "Before, we didn't know anything."

But whether the changes in the statewide system — which standardized the quantity and types of services people receive at the 39 mental health centers — have improved the quality of care is still unclear because the centers never tracked data the way they do now, said Jim Van Norman, medical director at Austin Travis County Integral Care.

"We're five years out, and we still don't know if the system is better than it was before," Van Norman said.

More state funding

Advocates for people with mental illness say the need for reform stemmed from Texas' long history of underfunding psychiatric services.

In fiscal year 2006, Texas ranked 50th in the country in per capita mental health spending at $34.57, according to a 2009 report by the Henry J. Kaiser Family Foundation, which ranked the 50 states and the District of Columbia. The only state below Texas is New Mexico, which spends $25.58. The national average is $103.53.

The limited funds have forced centers to limit the number of people it can serve.

There are more than 453,000 adults in Texas with serious and persistent mental illnesses, according to the Department of State Health Services. Not all seek care at the state-funded centers. Last year, the centers served more than 115,000.

The new rules, implemented in 2004, required centers to provide a minimum number of hours of state-approved services to each patient. It forced them to routinely reassess patients, carefully track services provided and report such information to the Department of State Health Services.

"We hoped that it would be a triage tool, that it would ensure the most limited resources were used on the most seriously ill," said Joe Lovelace, former executive director of the National Alliance on Mental Illness Texas, which advocated for the changes.

Since then, the state has ramped up spending on mental health care. This year, legislators allocated $55 million to expand services at local mental health centers. That money will fund additional services, such as psychiatric follow-up, case management, housing assistance, peer-support programs, at-home life skills training, physician visits and medication.

This fiscal year, community mental health centers will receive $341.8 million from the state. That does not include the $55 million.

The money is the second shot of cash to the system in recent years. In 2007, legislators approved $82 million to the centers for additional crisis services, which is immediate care for people who are suicidal or potentially violent. The money paid for things such as mobile outreach units, crisis hotline improvements and pay for specially trained mental health law enforcement officers.

The new money has allowed more people to get help, Maples said.

Between September 2006 and August 2007, 8,890 people received care through Psychiatric Emergency Services, the crisis center run by Austin Travis County Integral Care. Between September 2008 and August 2009 — after the center had received $4.6 million in crisis funding — the center served 10,707 people.

Statewide, the number of people being served by community mental health centers increased from 111,000 in 2007 to almost 116,000 in 2009, a jump Maples attributes partly to the new crisis services.

"When you expand crisis services, you're all but advertising them to come," he said.

Robert Wittmer credits that kind of care with keeping him alive.

Wittmer, who is 41 and suffers from major depression, was living in his car, hotels and homeless shelters when he connected with Integral Care in 2007. The center gave him medication, supportive housing, substance abuse services, counseling and other services, he said.

He still struggles, he said. He's been suicidal and spent time at a local psychiatric hospital. But he says the local mental health center gives him whatever he needs to stabilize.

"For me, it's been great," Wittmer said.

Waiting lists grow

But thousands of others are still waiting.

Integral Care's waiting list hovers between 800 and 900 people and takes about 13 months for patients to reach the front of the line. The Bluebonnet Trails Mental Health and Mental Retardation Center in Williamson County has a 100-adult list that takes six to eight months to get services. The Mental Health and Mental Retardation Center Authority of Harris County has a list of more than 600 people. Though the average patient there waits about three months for service, some have waited up to a year.

Requiring the centers to create formal waiting lists "finally (put) a spotlight on the scope of the need," Van Norman said. "We've got a better sense of services offered and where the gaps were."

But it's hard to move people out of the system — and off the waiting lists and into services — because of the shortage of mental health care for the indigent in communities throughout Texas, he said. Few psychiatrists take Medicaid, and many primary care doctors refuse to prescribe psychiatric medications because mental health is not their specialty. In Travis County, the CommUnityCare clinics, which provide medical care to low-income people and are funded by the Travis County Healthcare District, are overwhelmed. That puts more pressure on the state mental health centers, which often serve more people than the state is paying them to help.

Integral Care, for example, is paid by the state to serve about 3,000 adults, Van Norman said. They are serving 4,800, which they accomplish by increasing staffers' caseloads.

"It's not a good situation, because then things fall through the cracks," Van Norman said.

Advocates say serving so many people has not only made it difficult for patients to get into the system, it's also easier to get kicked out.

"If you miss an appointment, you get dropped right away," said Shannon Carr, executive director of the Austin Area Mental Health Consumers, which provides classes, support groups and other services for people with psychiatric illnesses.

Carr says she knows of multiple cases in which this has happened.

But it shouldn't, Van Norman said. When someone has missed an appointment, center staffers are supposed to try to contact the patient several times to reschedule, he said.

However, he said he knows staffers don't always do that because they are overwhelmed with other duties. The center recently stepped up efforts to ensure staffers make a "good faith effort," to contact patients, he said.

Patients say it can be difficult to reschedule.

Jodi Tidwell, a 38-year-old Wimberley woman with bipolar disorder, receives services though the Hill Country Community Mental Health Mental Retardation Center. In April, Tidwell, a part-time communications assistant who does not have insurance, missed an appointment because her daughter was in the hospital. Tidwell says she tried to reschedule in June, but employees were sick, appointments were cancelled and it was finally determined that the psychiatrist could not see her until January.

In early September, Tidwell ran out of medicine. She says she bought Cymbalta from a friend. She used Lamictal a family member no longer needed. She rationed her drugs.

By late November, Tidwell said, she was depressed and teary. Two days before Thanksgiving, Tidwell said, center staffers gave her a prescription for one of her medications. They also moved up her appointment to December.

"The individual doctors, nurses and coordinators care, but policies keep them from being able to treat us as patients," Tidwell said. "They see us as binders full of perfectly filled-out records."

Linda Werlein, chief executive officer for the center, which is in Kerrville, said privacy laws prohibited her from discussing Tidwell's case. But in general, she said, "if someone consistently does not come to the clinic and make appointments" then they have to wait to see a doctor before they get their prescriptions.

People who are in crisis can be served quickly during emergencies, she said.

Filling in the gaps

But many will never get into the public mental health system at all. Thousands have been transitioned out of services because they did not meet the new diagnosis criteria.

So where did they go? Some were likely recategorized so they fit into services at the centers, Van Norman said. Others have gone to the public health clinics or local nonprofits.

After the new system began, other community organizations started putting more money into mental health services to help fill the gaps.

The Travis County Healthcare District now funds 18 psychiatric hospital beds, which serve about 1,000 people a year. Since 2006, the St. David's Community Health Foundation has given more than $7 million to nonprofits that provide mental health services.

"This is part of who we are in the community and we need to start addressing the unmet need," said Bobbie Barker, the foundation's vice president for grants and community programs.

Some end up in the criminal justice system.

Eric Willard, a board member with the National Alliance on Mental Illness Texas, is also chief of the mental health unit for the El Paso County public defender's office. Of the 500 new clients he sees each year, about half have disorders that would likely make them ineligible for services, he said.

"I think it's a travesty," he said. "I think the state of Texas needs to be horsewhipped for what it's done to the mentally ill."

State Rep. John Davis, R-Houston, who has lobbied for more mental health money, said he hopes legislators will continue to increase funding.

"Sometimes it's a hard sell, but you just keep with it because it's important," he said. "These are the most vulnerable people."

After her 18-year-old son Jared's suicide, Carol Johnson said she felt helpless and even had thoughts of taking her own life.

But, with the help of a group called Compassionate Friends and networking with others who have suffered a loss of a loved one by their own hand, the Lindale native was able to regain control of her life and move forward.Ms. Johnson is now armed with experience and ready to help others with her newly founded group, Touched by Suicide.

But Ms. Johnson said those contemplating suicide need more help in East Texas, and prevention and signs should be taught in local schools to help battle the problem with school-age children and to teach them early that help is available.

“Suicide is part of an illness. You don't just wake up one day and say, ‘I'm going to kill myself.' There needs to be more education on this subject, because every 16 minutes in this country alone someone takes their life,” she said.

COMFORT AND HOPEJoy Biggs said she too struggled with every day life after her son Josh Dunlap took his life in 2004.

As she reached out for help, she quickly learned there were no groups in the area for those left behind by suicide.

Ms. Biggs said she researched and learned there was a Suicide Survival Therapy course in Dallas, so for eight weeks, she traveled back and forth to attend the classes.

“It was very helpful and taught me how to deal with some of the feelings I had. Josh was my son and I just felt like at times I had failed him in some ways. There was a lot of guilt,” she said.

According to the American Foundation for Suicide Prevention, the feelings for those left behind after a family member commits suicide include shock, symptoms of depression, anger, relief (because it may have ended a long and difficult mental illness) and guilt.

Ms. Biggs, Ms. Johnson and David Terrell, who lost his son Andy to suicide in 2003, all said the help and support from others going through the same thing is what pulled them through the difficult times.

“There is no map on this path to becoming whole after the loss of a loved one to suicide. It is the most painful of journeys — full of twists and turns, bruised hearts and misunderstandings. Small wonders appear on this path, but we may be too sore or fragile to recognize them. But there will be a day when you can look back and know that they were there,” the AFSP Survivor Council states in a brochure.In Dallas organizers have put together conferences and “Out of the Darkness Walks” to bring survivors together and to gain attention for their cause.

Ms. Johnson said while her group is relatively new, it already is helping those who are participating, and she hopes to grow the group so that more families can begin the healing process.

“I know someone that had not talked about the suicide in their family for 20 years. That is a long time to hold something in, and now they are talking about it and it is helping,” she said.

EDUCATION AND PREVENTIONThe main resources for those contemplating suicide in the Tyler area are the Andrews Center and the East Texas Medical Center's Behavioral Health Center, but there is no area crisis line where one can talk immediately to a trained counselor.

Lacy Canion, ETMC Behavioral Health Center operations manager, said the reason is because of the possibility for liability.

Ms. Canion said she lost an immediate family member to suicide after she began her career in helping others, and she knows the pain of wondering why a family member would take his or her life.

Ms. Canion agreed with Ms. Johnson and Ms. Biggs, saying more could be done, but added her facility has trained counselors and psychiatric professionals to work with those with thoughts of suicide.

Ms. Johnson said, however, that everyday people need to be educated about the signs of someone thinking about suicide because often times the hospitals will release a person after a few days, and then they are thrust back into reality with all of the same problems.

The hospital “had Jared for four days, and then they sent him home with no instructions as to what I should do or look for,” she said.Terrell said prevention begins with discussion and Ms. Biggs said schools need to get on board and start programs for children.

“There needs to be more discussion about this because it is very real and it affects a lot of people,” Terrell said. “The people who commit suicide truly believe there is no other way. The more we can talk about it, then the chances of preventing it increases,” Terrell said.

SIGNS AND WARNINGSProfessionals say there are clear warning signs when it comes to someone thinking about suicide and knowing the signs can save a life.

According to the AFSP, the imminent dangers include threatening to hurt or harm self, looking for ways to kill self, talking or writing about death, dying or suicide, or has made plans for a serious attempt. Someone who starts giving all of their possessions away also may be contemplating suicide.Other indicators may include insomnia, intense anxiety or panic attacks, a feeling of being trapped or hopeless, full of rage and anger or feeling as if there is no reason to live.

Between 50 and 75 percent of all suicides had warning signs, and the person had give some warning of their intentions to a friend or family member.Professionals say if you notice the signs in a loved one, then talk to them and if needed seek help immediately.

Ms. Biggs said her son had two failed suicide attempts before he took his life, but she said he did display the warning signs.

However, she added he knew how to say just the right things and was even released from hospitals because he convinced the professionals he was OK.Ms. Johnson said she is optimistic because the topic of suicide is finally garnering the attention of the U.S. military and she hopes studies the government is doing will give new insights about the problem.

“We need more prevention and just talking about it is a prevention tool. By not talking about it we are just ostracizing people,” she said.Ms. Johnson’s group meets the second Tuesday of every month at the East Texas Center for Independent Living, 4713 Troup Highway. Ms. Johnson said anyone who wants to attend can call her at 903-574-3127.

Sunday, December 6, 2009

By KENNETH DEANStaff WriterLINK to Tyler Morning TelegraphEmotions rack the mind with numbing pain, mixed with feelings of disbelief and seething anger, as friends and family struggle to find words to comfort those left behind when a loved one commits suicide.

Society has placed a stigma on suicide, which not only condemns the person who has committed suicide, but in many cases, sees people abandon their friends and family because they fear the unmentionable act might spread to their own family.

"Talking about suicide is like saying 'sex' and 'pregnant' in the 1940s and 50s. Everyone is afraid it will spread and it's not sociably acceptable to talk about," David Terrell said.

If you are experiencing thoughts of suicide and wish to talk to someone, call 1-800-273-TALK (8255) to be connected to a suicide prevention and crisis center in your area.

A suicide and crisis number for the Dallas area is 1-866-672-5100.

For more information about the American Foundation for Suicide Prevention visit the organization's Web site at www.afsp.org.

Touched by Suicide, contact Carol Johnson at 903-574-3127.

Terrell and several others agreed to sit down with the Tyler Courier-Times--Telegraph recently and speak candidly about the effects suicide has had on themselves and their families.

One main point the group wanted to punctuate is that any family can be touched by suicide. Statistics now show every 16 minutes, someone commits suicide in America.

THE ANGERThose gathered talked about a wide variety of emotions they have dealt with over the years, but they all agreed anger surfaced more than the rest.

"The worst thing is there is no one to blame. You have all of this anger but no one to really be angry at because that person is the person you loved. If someone walked up and shot my son dead, then I could be angry at them. But I loved my son, so how can I be angry at him?" Terrell said as tears filled his eyes.

Terrell's son, John Andrew "Andy" Terrell, was 31 when he took his life by hanging himself at Pier 1 Imports in Tyler on Nov. 25, 2003 after struggling with marriage and financial problems.

Terrell said he talked to his son the night before he died and the conversation was of pending plans for Thanksgiving, with no indication anything was wrong.

"He told me, 'I'll see you this weekend,' and the next morning I was called and told he had hung himself," he said.

Joy Biggs said she was mad at the doctors involved in her son Josh Dunlap's care because instead of giving him psychiatric counseling for his Obsessive Compulsive Disorder, they prescribed a variety of medicines.

Josh Biggs, who had just completed his master's degree in landscape architecture, took his life in a motel room on May 24, 2004, after at least two attempts at the age of 32.

His mother said her son was tormented with his illness for years and suffered greatly from long-term insomnia, which only served to intensify his mental illness.

"He was just worn out with his battle with OCD. He was so ashamed of the illness that his closest and dearest friends didn't even know he had a problem," she said.

Biggs said psychiatry has moved too far into medicating the patients and away from psychotherapy with one-on-one treatment.

"You do have a lot of anger and it has to go somewhere," she said.

A DIRTY WORDThe word "suicide" is met with thoughts of weakness, one's inability to cope with society and a litany of other stigmas, but the loved ones left behind say it can happen to any family.

"It's not a weak person who commits suicide. It's a person with an illness. You don't just wake up and decide you're going to kill yourself," Carol Johnson said.

Johnson's 18-year-old son, Jared, shot and killed himself in a bathroom inside her home in Lindale on Sept. 27, 2005.

"He borrowed a gun from his grandmother to go "target shooting," hugged her, then went home, locked himself in the bathroom and shot himself," she said.

Johnson said her son had been treated for having thoughts of suicide, but had a lot of love and support and had been doing well up until his death.

"Suicide many times leaves loved ones being ostracized. I had people I knew that when I saw them in the grocery store after Jared's death they would walk the other way," she said.

Biggs agreed and added her thoughts on people and their beliefs about suicide.

"The ideas which are still circulating around in our society about suicide are archaic," she said. "We need some discussion about this because only that will get this out in the open."

With a raised quivering voice, Terrell said he had people tell him his son was in Purgatory because he took his own life.

"That is not something a parent wants to hear about their child and it is something that should not be said," he said as tears filled his eyes.

But, dealing with others and losing friends because a suicide has struck a family is only half of the effects -- the other is coping with the aftermath.

STRAINED RELATIONSHIPSAt her special place in the Tyler Children's Park, Biggs remembers her son, Josh, and exhales to catch her breath.

Biggs explained Josh had been a part of the early planning of the park and he told her one day she would need a special place all to herself.

"I go there to think and be close to him. It is my special place," she said. "This was my son and I loved him and I just want to be close to him."

Terrell said his son's death changed his family forever and left it shattered.

"My (former) wife has a different husband and I have a different wife. Suicide changes everything and nothing is the same from the day it happens," he said. "I am not the same before Andy's death and neither is my wife."

Biggs and Terrell agreed, saying they lost friendships and relationships within the family unit are strained to breaking points.

"Suicide leaves a fractured family. My daughter said our family was like Humpty Dumpty. We've been put back together, but the cracks are still there and they run deep," Biggs said.

As a family struggles to find itself after suicide, there are many issues to deal with to attempt to move forward.

Johnson said for her, the main obstacle to overcome surrounding her son's death was the guilt.

"As a mom, the guilt was horrible at first. I loved Jared and still love him, but I am finally free of the guilt. After a lot of time and talking to others, I finally know I didn't do anything wrong," she said.

Monday: The series continues with a look at prevention and services for families struck by suicide.

Friday, November 13, 2009

Katy Aisenberg, a psychologist in private practice in Cambridge, reflects on recent events and the often invisible stress that mental health providers endure:

As the nation held its breath, waiting for news about health care, violent acts were committed against a caregiver to the mentally ill and by a caregiver himself. The psychiatrist in Fort Hood who shot military men and women was preceded by a more intimate tragedy. At Massachusetts General Hospital a bi-polar man, at an outpatient appointment, attacked his psychiatrist, a female doctor and was killed by a security guard who happened on the scene.

The following day I sat in my office and wondered, not for the first time, if I might get killed by a patient or have a death on my hands. And I thought (unlike many) how amazing it is that these events do not happen daily.

Mental illness shows no prejudice: it is invisible and slippery. Progress is difficult to measure and the care is given by people who are tired, severely underpaid, suffer compassion fatique and vicarious traumatization. We live in two worlds — often at the boundary of madness. Then we walk back into the bright, well-lit rooms of our homes or our children’s school and try to forget what we know.

But at such an important moment of change, as we contemplate our American health care “system” we need to review the state of mental illness. Thirteen years ago I began treating young women who were dying from eating disorders. I was tremendously optimistic about change in my field. Taboos were lifted and therapy became widely acceptable as did new and effective psychotropic medication.

Yet, in fact, the opposite has happened. I see more and younger women succumb to eating disorders. We know what treatment is but there are fewer places for this treatment. I also see the power of our modern culture: we speed up our pace of achievement but are fed less nourishment. We have less free time, vacation time, time with our own children. Rarely do we have time to read and reflect upon what we do. We refuse ourselves the precise self-care which we insist is essential for our patients.

Mental illness — the invisble dark cloak of depression, the shaking hands of the anxious, the rude voices of schizophrenia — is one of America’s untouched frontiers. We believe that people with cancer are due every bit of bone marrow they can find. Yet we leave our ill to sit in squalor with demons in their heads. No one visits or calls. Loneliness is the chief complaint of most of my patients.

Something in us still dares not name mental illness when we see it. Others of us trust everyday that the relationship we have formed with our patients—the web of connection thrown over an abyss, will hold. The anxiety, depression, and psychosis caregivers metabolize is staggering. We do it because we are curious, compassionate and believe we are not doing hospice work. I remain deeply troubled as to why this profession goes undervalued when it is lifesaving and lifeaffirming.

Our country is still adolescent. We believe death will not happen to us. We believe that unattractive aging is optional. We believe there is an ‘us and a ‘them.’ Until that prejudice is dropped and we understand that mental illness is often a cruel accident of birth, we will never provide adequately for mental illness in those we care for or those who give care. The valedictorian of the class, the doctor’s wife who requires weekly restraints, the college roommate who kills himself while writing a book….all of these real people are just a few cracks in the pavement away from us. There is nothing especially ‘other’ about mental illness. Perhaps that is why it scares us so.

Sunday, November 8, 2009

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.

Sunday, October 25, 2009

Thursday, October 8, 2009

An estimated 60 million Americans suffer from mental illness. One local photographer is working to raise awareness about their stories. He and others have made it their mission to break down stigmas associated with these disorders.

Wednesday, October 7, 2009

This report provides an update on mental health transformation accomplishments in FY 2009, including: a new conceptualization of the project, an updated version of the Texas CMHP goals and subgoals, and progress on all project activities; presents priority projects and measures for the remainder of the grant period; describes how transformation will be sustained when federal funding ceases; and presents the MHT Evaluation Plan and how achievement of Texas CMHP goals will be tracked and measured for the remainder of the grant period Posted October 2009.

Via Hope, is Texas Mental Health Resource that willprovide mental health training and technicalassistance for mental health consumers, youth, familymembers and other stakeholders. Via Hope isan effort supported by a partnership with theDepartment of State Health Services, Mental HealthAmerica of Texas and the National Alliance on MentalIllness of Texas to transform mental health servicesstatewide.Here's the presentation.

Sunday, October 4, 2009

Mental Illness Awareness Week: What You Should Know, Including PBS Broadcasts, Oct. 4-10

Mental Illness Awareness Week (MIAW) is Oct. 4-10, 2009 and as part of its observance, the National Alliance on Mental Illness (NAMI) is calling attention to a program now airing on PBS, Minds on the Edge: Facing Mental Illness.

Observed annually the first full week in October, Congress established MIAW as a time to raise public awareness of serious mental illnesses such as major depression, bipolar disorder and schizophrenia. Other diagnoses include post traumatic stress disorder (PTSD) and anxiety disorders, including obsessive-compulsive disorder and borderline personality disorder.

* About 60 million Americans experience mental health problems in any given year. One in 17 lives with the most serious conditions. Less than one-third get treatment. * One-half of all lifetime cases begin by age 14, but 10 or more years may pass between onset of symptoms and getting help.

Section 3.1 of the NAMI Texas Board Operating Policies and Procedures states, “All projects, activities, and partnerships of NAMI, its state organizations, and local affiliates must conform to NAMI National Bylaws and policies.”

Individual members might have differing views on Health Care Reform, but they should only put forth those views as individual citizens and not speaking for NAMI Texas or for their individual affiliates. Articles in local affiliate newsletters and/or public statements made by affiliate or state leaders in their capacity as representatives of their organization shall not voice positions differing from NAMI national’s policies and positions.

Monday, September 21, 2009

17th EditionTexas LawsRelating to Mental HealthReflecting changes in law passed by the81st Legislature, Regular Session – 2009*Throughout this book will be various statutory references to the Texas Department of Mental Health and Mental Retardation, Texas Commission on Alcohol and Drug Abuse and the Texas Department of Health. On September 1, 2004 these three agencies were combined to form the Department of State Health Services. Any reference in statue to the legacy agencies should be read to mean the Department of State Health Services.Disclaimer – The information contained in this book does not constitute the provision of legal advice. While every attempt has been made to ensure the accuracy of the information contained in this book, the Department of State Health Services, its officers and employees disclaim any responsibility for any errors in content or formatting that may be contained herein.*Most changes in law reflected in this book become effective on 9/1/09.

Monday, September 14, 2009

Last week the Kaiser Family Foundation released an issue brief examining how individuals with complex health care needs might fare in a reformed health system. The report, Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage , analyzed healthcare coverage for three individuals and cost sharing requirements to the Blue Cross Blue Shield Standard Option plan offered to Members of Congress and federal workers under the Federal Employees Health Benefits Program (cited as benchmark under a reformed health care system), and also takes into consideration Medicaid coverage.

What this study shows is that coverage for persons with complex health needs may be significant and broad - still containing cost provisions that are beyond the financial reach of middle class workers. They offer examples of disabilities that require treatments which could range up to $12,000 annually and out of pocket expenses from $21,000 to $32,000 for long-term care costs under such plans.

This study adds an important dimension to policy issues for people who would have health insurance coverage extended to include them - what benefits does that coverage include? The question cannot be answered accurately without careful examination of cost sharing and out of pocket expenses. To view and download the report, go to: http://www.kff.org/healthreform/upload/7967.pdf .

Thursday, August 27, 2009

NAMI mourns the passing of U.S. Senator Edward M. Kennedy, a true champion for individuals and families affected by serious mental illness. This is a profound loss for the NAMI family.

We do not have to struggle to remember what Senator Kennedy accomplished in seeking to improve the lives of millions of Americans. The real challenge would be to try to recall what he didn’t do. His idealism moved the country. His pragmatism and ability to work with liberals and conservatives alike enacted legislation.

Steve Lopez encouraged several hundred incoming freshmen at the University of Texas at Tyler to develop a passion that would define their lives.

Lopez, the author and Los Angeles Times columnist who is portrayed by actor Robert Downey Jr. in the film "The Soloist," was the guest speaker at the freshmen convocation held in the R. Don Cowan Performing Arts Center on Tuesday morning.

Beginning in February 2005, Lopez began writing a series of columns about a homeless man he saw playing a two-stringed violin on Los Angeles' Skid Row. What was initially a piece about a "violin man," exploded into something much larger, igniting what Lopez describes as an unlikely friendship as well as a shifting his point of view regarding the city's homeless population.

While the columns, book and feature film have provided Lopez with national recognition, he considers the real gift to be the day he met Nathaniel Anthony Ayers. The meeting launched a friendship, and Ayers gave Lopez a new perspective.

Early on in his life, Ayers was a promising, naturally talented musician studying at The Juilliard School in New York City. However, a mental breakdown and schizophrenia left him reduced to living on the streets, crushing cockroaches and keeping sticks to ward off rats at night. His musical talent remains, however, despite often not being able to tell the difference between what is real and what is imagined.

Encountering Ayers, Lopez said his eyes were opened to the lack of attention society pays to those with mental illness.

"We wouldn't let 7,000 people crush cockroaches and go to sleep on the pavement of any city if they had cancer, if they had muscular dystrophy. It's OK because it's mental illness and we don't want to deal with it and we haven't through the decades and we've never come to grips with that. But that's not acceptable either, and Mr. Ayers has shown us why," Lopez said. "He's made it clear that those people are not strangers, they are our brothers and sisters, our sons and daughters, and that we can do better. I was never a giver. And I found so many rewards, probably in part because of the great challenges. It was a gift the day I met Mr. Ayers."

Lopez said Ayers has progressed. He no longer refuses assistance for housing and has begun to talk about his mental illness, thanks in part to watching the film, "The Soloist," Lopez said.

During his brief time at Juilliard, Ayers was a classmate of world renowned cellist Yo-Yo Ma. However, because of Ayers' perseverance, Lopez said he considers his friend to be more successful in life than Ma.

"They were launched from the same stage at the same time, which one though, really has been more successful? It's obvious Yo-Yo Ma became an international icon. Few people in the history of classical music have had commercial success like he has, but Nathaniel wakes up every day fighting demons, trying to distinguish between the real and the imagined," Lopez said.

"And each and every day he gets through that with his belief in music. And he clears a space and whether he plays the cello or the piano or the violin or the string bass or the flute, trumpet or French horn, he finds peace and it is because he has this passion that nothing can defeat. Few people in this world ever find this passion. I hope that you find it at UT Tyler. I hope you find something in your life that gives you purpose. Nathaniel's got it. And, to me in some ways, given his challenges, he is the more successful of the two when you look at Yo-Yo Ma and Nathaniel Ayers."

Lopez said his passion continues to be writing, thanks to Ayers.

"I think he reconnected me with column writing. I had done it for so long. I thought maybe I should try something else with the last years of my working life," he said. "But I think Nathaniel reminded me how much I enjoy doing this. I feel privileged all over again to have a stage. And that's more precious to me now, having gotten the chance to write about Nathaniel and do so in ways that might be helpful to educate people on public policy issues. So it's as if that longtime passion had been rekindled by him."

Monday, August 17, 2009

Time to Change, the mental health anti-stigma campaign, launches two provocative films aimed at challenging the stigma surrounding mental health head on. Both films are launched as an exclusive YouGov poll reveals that more than a third of the public believe people diagnosed with schizophrenia are likely to be violent. The reality is that people are as likely to be struck by lightning as to be harmed by a stranger with a mental illness. Research also shows that support from friends and family helps people with mental illness get better, faster and for longer. People going through it say that the stigma and shame can be worse than the illness itself.

President Obama shared his vision for health care reform—and stressed his support of mental health parity—at a New Hampshire town hall meeting on Aug. 11.

Linda Becher, an audience member, specifically asked the president about access to mental health care and its impact on society. The president acknowledged the seriousness of mental illnesses and the reality that many existing insurance policies do not cover them on the same terms as physical illnesses. President Obama also expressed his desire to include mental health care as part of health care reform.

Q Hello, Mr. President. My name is Linda Becher (ph). I'm from Portsmouth and I have proudly taught at this high school for 37 years…I've been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the -- (applause) -- you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who's got a broken leg. But a broken leg, nobody argues that's covered. Severe depression, unfortunately, oftentimes isn't even under existing insurance policies.

So I think -- I've been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

Sunday, August 16, 2009

MTV Networks casting director is "currently working on a new documentary series about young people living with a mental illness.

They are specifically looking for 18-25 year-olds living in the continental U.S. who have been diagnosed with a mental illness, such as OCD, bi-polar disorder, depression or schizophrenia. They should be open and honest about sharing the ups and down of living with this disease, including the effect it has on their family and friendships, any side effects from medications, any therapies they're engaging in, any challenges they take on in their academic and/or professional lives, etc. They should have a willingness to share the daily battles they encounter and a desire to raise awareness and tolerance of their illness with their audience of peers.

If you know someone who may be a great candidate for this show, please have them contact me directly - and please forward this email along to anyone you feel may be helpful."

Saturday, August 15, 2009

Scope of the ProblemPoor and partial-adherence to treatment presents staggering obstacles to recovery. It is associated with a poorer course of illness, increased involuntary hospitalizations, suicide, poorer subsequent response to treatment, estrangement and discord with caregivers and providers, criminal behavior, and failure to reach optimal levels of recovery. In light of the tremendous advances made in the treatment of schizophrenia and bipolar disorder, the tragedy of both untreated, and inadequately treated, mental illness is compounded. The urgency to implement strategies that optimize adherence and recovery has never been greater. Non-adherence rates in schizophrenia and bipolar disorder continue to hover around 50% while partial adherence rates are even higher (75%). Considering that millions of people either flat out refuse to participate in treatment, or if they do, practice only partial-adherence, the "real-world" effectiveness of both the older, and more promising newer treatments, is abysmal. Deficits in insight (a.k.a. "anosognosia" see DSM IV-TR, American Psychiatric Association Press, 2000, page 304) are very common. Not surprisingly, anosognosia predicts poor and partial-adherence. After all, who would want to take medication for an illness they did not believe they had? Research shows that poor insight is among the top predictors of poor adherence, far more predictive than the person's experience of side effects. Although recent innovations in drugs used to treat these disorders have addressed many of the limitations of traditional antipsychotic medications (e.g., severity of side effects, aspects of cognitive dysfunction), they still do not deal with the problem of poor adherence to treatment.